Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse Implications for Transcatheter Mitral Valve Implantation

JACC-CARDIOVASCULAR IMAGING

卷:9

Article

Naoum, Christopher^1,2  Leipsic, Jonathon^1,2  Cheung, Anson^1,2  Ye, Jian^1,2  Bilbey, Nicolas^1,2  Mak, George^1,2  Berger, Adam^1,2  Dvir, Danny^1,2  Arepalli, Chesnal^1,2  Grewal, Jasmine^1,2  Muller, David³  Murphy, Darra^1,2  Hague, Cameron^1,2  Piazza, Nicolo⁴  Webb, John^1,2  Blanke, Philipp^1,2 

[1] St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada

[2] Univ British Columbia, Ctr Heart Valve Innovat, Vancouver, BC V5Z 1M9, Canada

[3] St Vincents Hosp, Sydney, NSW 2010, Australia

[4] McGill Univ, Ctr Hlth, Div Cardiol, Dept Med, Montreal, PQ, Canada

关键词: computed tomography;    mitral annulus;    mitral regurgitation;    TMVI;    TMVR;    transcatheter mitral valve implantation;   

DOI  :  10.1016/j.jcmg.2015.08.022

来源: Elsevier

【 摘 要 】

OBJECTIVES The aims of this study were to determine D-shaped mitral annulus (MA) dimensions in control subjects without significant cardiac disease and in patients with moderate to severe mitral regurgitation (MR)being considered for transcatheter mitral therapy and to determine predictors of annular size, using cardiac computed tomography. BACKGROUND The recently introduced D-shaped method of MA segmentation represents a biomechanically appropriate approach for annular sizing prior to transcatheter mitral valve implantation. METHODS Patients who had retrospectively gated cardiac computed tomography performed at our institution (2012 to 2014) and were free of significant cardiac disease were included as controls (n = 88; 56 +/- 11 years of age; 47% female) and were compared with patients with moderate or severe MR due to functional mitral regurgitation (FMR) (n = 27) or mitral valve prolapse (MVP) (n = 32). MA dimensions (projected area, perimeter, intercommissural, and septal-to-lateral distance), maximal left atrial (LA) volumes, and phasic left ventricular volumes were measured. RESULTS MA dimensions were larger in patients with FMR or MVP compared with controls (area index 4.7 +/- 0.6 cm(2)/m(2), 6.0 +/- 1.3 cm(2)/m2, and 7.3 +/- 1.7 cm(2)/m2; perimeter index 59 +/- 5 mm/m(2), 67 +/- 9 mm/m(2), and 75 +/- 10 mm/m(2); intercommissural distance index 20.2 +/- 1.9 mm/m(2), 21.2 +/- 3.1 mm/m(2), and 24.7 +/- 3.2 mm/m(2); septal-to-lateral distance index 14.8 +/- 1.6, 18.1 +/- 3.3, and 19.5 +/- 3.4 mm/m(2) in controls and patients with FMR and MVP, respectively; p < 0.05 between controls and MR subgroups). Absolute MA area was 18% larger in patients with MVP than patients with FMR (13.0 +/- 2.9 cm(2) vs. 11.0 +/- 2.3 cm(2); p = 0.006). Although LA and left ventricular volumes were both independently associated with MA area index in controls and patients with MVP, only LA volume was associated with annular size in patients with FMR. CONCLUSIONS Moderate to severe MR was associated with increased MA dimensions, especially among patients with MVP compared with control subjects without cardiac disease. Moreover, unlike in controls and patients with MVP, annular enlargement in FMR was more closely associated with LA dilation. (C) 2016 by the American College of Cardiology Foundation.

【 授权许可】

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